DISTRICT COURT FOR THURSTON COUNTY, WASHINGTON
IN THE MATTER of the Change of Name of
)
No. ______________________
)
)
PETITION FOR ADULT NAME CHANGE
Petitioner is a resident of Thurston County, Washington. Petitioner does not seek this name change to
defraud or mislead any person. Petitioner declares further: (check all boxes that pertain to you)
I wish to change my name from: ___________________________________________________
(C urrent First, Middle and Last Name)
to: ______________________________________________________
(Proposed First, Middle and Last Name)
Petitioner is currently under the jurisdiction of the Department of Corrections (DOC) and will submit a copy of
the Petition for
Name Change to DOC at least five (5) days prior to this hearing.
Petitioner is subject to registration requirements as a sex offender and will submit a copy of this application
to the
Sheriff of the petitioner’s county of residence and to the Washington State Patrol at least five (5) days prior
to this hearing.
A photo ID is presented with this Petition.
Petitioner is _______ years of age.
This application is made for the following reasons:
I have used the following additional name(s) either currently or in the past: If none, then enter “none.”
1. ____________________________________________ 2.___________________________________________
(First)
(Middle)
(Last)
(First)
(Middle)
(Last)
I declare under penalty of perjury under the laws of the State of Washington that the statements in this petition are
true and correct and that I have checked all boxes that pertain to me.
Signed at ________________________________________________, on ________________________________.
(City and State)
(Date)
_________________________________________________
(Petitioner’s Printed Full, Middle and Last Name)
(Petitioner’s Signature)
A hearing on this Petition will be held __________________________, 2________at ________ [ ] am [ ] pm.
Updated: 05/28/2014